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Understanding Rheumatoid Arthritis Associated Interstitial Lung Disease (RA-ILD)

Rheumatoid arthritis (RA) is a condition that not only affects the joints but can also impact various organs in the body, including the lungs. One of the complications associated with RA is Interstitial Lung Disease (ILD), specifically known as RA-ILD. This blog aims to shed light on RA-ILD, its diagnosis, and available treatments, all while maintaining an optimistic outlook.

What is Interstitial Lung Disease?

Let's start with a basic understanding of the lungs and the complexities involved. When considering lung disease, it's essential to recognize that issues can arise in different areas. It's not just about the airways or pleura; there's a crucial barrier involved in oxygen exchange between the air and blood vessels within the lungs (see picture). Interstitial lung disease refers to conditions affecting the tissue between the alveoli (air sacs) in the lungs and the blood vessels. This impacts the barrier responsible for oxygen exchange, leading to decreased oxygen levels and compromised respiratory function.

RA's Impact on the Lungs

RA isn't limited to joint inflammation. It can manifest in various pulmonary conditions—pleural inflammation, bronchitis, or even the formation of rheumatoid nodules causing coughing of blood. However, one of the most critical concerns is the development of interstitial lung disease as it can lead to respiratory failure. As I often say, we aim for remission in RA because we do not treat “just” the joints! It's crucial to manage RA effectively, not just for joint health but to potentially prevent the onset of RA-ILD.

Understanding the Progression

We think that the progression of RA-ILD typically initiates with inflammation, progressing to scarring (fibrosis). Once scarring occurs, reverting the tissue to its original state becomes impossible. However, proactive treatment can prevent further deterioration, even if it can't (yet?) reverse existing scarring—a goal for future medical advancements.

Diagnosing RA-ILD

Interestingly, RA-ILD often presents similarly to another condition called idiopathic pulmonary fibrosis (IPF), usually around the age of 60-65. Diagnosis involves a combination of clinical symptoms, imaging (chest X-rays and high-resolution CT scans), and pulmonary function tests. Notably, with the improved quality of CT scans, we now very rarely need a lung biopsy for diagnosis, a relief considering past practices.

Optimistic Outlook, Prevention and Treatment Approaches

There's reason for optimism in RA-ILD, primarily linked to treating RA effectively. Achieving minimal disease activity and remission in RA may potentially deter the development or worsening of RA-ILD. Achieving minimal disease activity and remission in RA may prevent the development of RA-ILD. 

Once diagnosed with RA-ILD, we need to work on both fronts (joints and Lungs). Making sure that the RA is well controlled while managing the ILD with treatments that are not considered toxic for the lungs, There are also some newer drugs specifically for fibrotic ILD which we can consider to prevent further damage to the lungs. 

Finally, prevention of any sort of further impairment to the lungs is paramount. Updating all vaccinations such as the Flu, Covid19, RSV and pneumonia can prevent infections in the lungs. Elevating the head during sleep can mitigate gastric acid reflux, which, if aspirated into the lungs, can worsen RA-ILD. 


In conclusion, managing RA effectively not only aids joint health but potentially guards against associated lung complications like RA-ILD. Through proactive treatment, effective collaboration with specialists, and preventive measures, individuals with RA can strive for better overall health and minimize the impact of RA-ILD on their lives.

Remember, optimism isn't just a perspective; it's a crucial part of the journey towards better health, even in the face of challenging conditions like RA-ILD.

Are you, or someone you love, looking for a rheumatologist? 

Are you looking for a highly skilled and trusted physician that can finally help you find what you have whether autoimmune or inflammatory?  Maybe you queried google for the “best rheumatologist in Denver” and felt that no other arthritis clinic in Denver really seemed personable? Or maybe you are simply looking for a doctor that will listen to you and work with you to achieve disease remission? We think that UnabridgedMD has the best rheumatologist in Denver and the best rheumatology practice in Colorado and we would love to work with you. 

You can schedule your first appointment at or schedule a free 15 minute discovery call with Dr. Amigues herself, so that we can make sure we are the right fit for you, here is the LINK to do so.

We cannot wait to welcome you to the UnabridgedMD family!


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